Desires to attend Sunday Church activities Name and Signature of

Desires to attend sunday church activities name and

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Desires to attend Sunday Church activities __________________________________ Name and Signature of Observer/Evaluator Date accomplished: ___________________ Hand Phone Number: _________________ E-mail Address: _____________________
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CHILD’S DEVELOPMENTAL SCALE RATED BY TEACHER/S Name of the Child:____________________________________________________________________ Birthday: ______________________________________________Age: _________________________ Grade level: ____________________________________Date Rated:___________________________ Current classification: _________________________________________________________________ Educational Placement/Program: _______________________________________________________ Rater: ________________________________________________________________________ Directions This scale designed to determine the child’s levels of five (5) developmental areas. Please rate the child as objectively as possible with the help of the SPED Teacher. Legend: HE = Highly Evident E = Evident SE = Slightly Evident NE = Not Evident PHYSICAL HEALTH – GROSS MOTOR The child: HE E SE NE 1. Possesses good health. [ ] [ ] [ ] [ ] 2. Has normal height and weight. [ ] [ ] [ ] [ ] 3. Follows good eating and sleeping habits. [ ] [ ] [ ] [ ] 4. Is normally strongly / fast / does not tire easily. [ ] [ ] [ ] [ ] 5. Is normally balanced / coordinated. [ ] [ ] [ ] [ ] 6. Moves about with ease / ability in performing gross – motor activities like walking, running, jumping, skipping, climbing and walking upstairs and downstairs. [ ] [ ] [ ] [ ]
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7. Performs simple chores like making his / her bed, Folding, washing his / her clothes, running errands and cleaning the house. [ ] [ ] [ ] [ ] 8. Uses age-appropriate play facilities. [ ] [ ] [ ] [ ] 9. Performs activities such as rhythmic, dancing, aerobics and calisthenics with ease. [ ] [ ] [ ] [ ] 10. Participates in games / sports recreation actively. [ ] [ ] [ ] [ ] 11. Discriminates and avoids dangers. [ ] [ ] [ ] [ ] FINE – MOTOR The child: HE E SE NE 1. Performs simple visual-motor tasks such as building blocks, sorting beads, putting forms in form board and pegs in pegboard. [ ] [ ] [ ] [ ] 2. Performs less easy visual-motor tasks such as assembling Lego pieces following patterns, forming puzzles, arranging objects in series according to certain rules, and replicating block arrangement and bead patterns. [ ] [ ] [ ] [ ] 3. Rolls/throws/catches/balls/objects coordinately and accurately. [ ] [ ] [ ] [ ] 4. Opens and closes bottles / jars. [ ] [ ] [ ] [ ] 5. Wipes surfaces efficiently. [ ] [ ] [ ] [ ] 6. Unbuttons and buttons clothes. [ ] [ ] [ ] [ ] 7. Wraps and unwraps objects / food. [ ] [ ] [ ] [ ] 8. Pours liquids / sand / beads / seeds into glass container. [ ] [ ] [ ] [ ] 9. Molds clay into different shapes / images. [ ] [ ] [ ] [ ] 10. Sharpens pencil using sharpener. [ ] [ ] [ ] [ ] 11. Fixes and ties shoelaces. [ ] [ ] [ ] [ ] 12. Sews simple stitches. [ ] [ ] [ ] [ ] 13. Uses table knife for spreading, slicing / cutting. [ ] [ ] [ ] [ ] 14. Cuts with scissors accurately. [ ] [ ] [ ] [ ] 15. Holds the pencil / crayon correctly. [ ] [ ] [ ] [ ] 16. Colors drawings within the lines. [ ] [ ] [ ] [ ] 17. Traces shapes / forms letters / numbers. [ ] [ ] [ ] [ ] 18. Draws objects/persons/and others. [ ] [ ] [ ] [ ] 19. Copies shapes / forms/letters/numbers/words accurately. [ ] [ ] [ ] [ ] PSYCHOSOCIAL The child: HE E SE NE 1. Describes himself/herself/accurately and adequately. [ ] [ ] [ ] [ ] 2. Identifies / describes family members. [ ] [ ] [ ] [ ] 3. Exhibits appropriate emotional responses. [ ] [ ] [ ] [ ] 4. Expresses his / her personal needs. [ ] [ ] [ ] [ ] 5. Cooperates well with family members / teachers and peers in work / play. [ ] [ ] [ ] [ ] 6. Uses polite expressions appropriately [ ] [ ] [ ] [ ] 7. Follows appropriate social rules expected of his/her age. [ ] [ ] [ ] [ ] 8. Compiles with request and commands. [ ] [ ] [ ] [ ] 9. Respects the members of the family, school and community. [ ] [ ] [ ] [ ] 10. Behaves properly in varied social settings. [ ] [ ] [ ] [ ] 11. Makes appropriate social judgments. [ ] [ ] [ ] [ ] 12. Observes family, school, community rules and ordinances. [ ] [ ] [ ] [ ] 13. Contributes in protecting and maintaining a wholesome and safe environment [ ] [ ] [ ] [ ]
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LANGUAGE COMMUNICATION
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